The Impact of Traumatic Brain Injury on Mental Health Care Utilization: A Propensity Matched Analysis of National Data

Abstract

Abstract Background: Mental health disorders are a common sequelae of traumatic brain injury (TBI) and are associated with worse health outcomes including increased mental health care utilization. This study addresses the methodical limitations of previous studies by examining the effect of TBI on mental health care utilization using propensity score matching analysis. Methods: Using data from a national survey, this study assessed mental health care utilization among those with a TBI, compared with a non-injured control group. Propensity score matching for age, sex, education, income, marital status, race, mental health comorbidities, and chronic conditions in a 4:1 ratio using nearest neighbor was performed. Conditional logistic regression then compared matched patients in terms of mental health care utilization. E-value sensitivity analysis was used to assess how strong an unmeasured confounder would have to be to explain away an observed relationship. Results: The matched study sample included 76,727 TBI patients and 307,510 non-injured controls with significantly improved balance in all baseline covariates. After conditional regression of the propensity-matched cohort, TBI remained a significant predictor of mental health care utilization (95% CI, 1.38-3.67), showing a 2.25-fold increased probability of mental health care utilization in TBI patients. Conclusions: This study is the first to evaluate the probability of mental health care utilization in TBI patients through a well-matched national cohort. TBI patients were more than twice as likely to use health care services for mental health complaints relative to those who were uninjured. Further longitudinal research is needed to evaluate the long-term mental health care utilization of TBI patients.